At 5 ft 7 inches, he weighed in at 273 lbs, putting his BMI at a sobering 42.8. (A BMI of 30 or above is classified as "obese.") In addition to lipoprotein(a), Jack had an extravagant quantity of small LDL (the evil "partner" of lipoprotein(a)), high triglycerides, and blood sugars in the diabetic range. With a heart scan score of 1670, Jack had little room for compromises.

Try as he might, Jack could simply not stick to the diet I urged him to follow. Three days, for instance, of avoiding wheat was promptly interrupted by his wife's tempting him with a nice BLT sandwich. This triggered his appetite, with diet spiraling downward in short order.

So I taught Jack how to check his blood sugars using a fingerstick device, what I call the most important weight loss tool available. I asked Jack to check his pre-meal blood glucose and his one-hour after-meal blood glucose and not allow the after-meal blood glucose to rise any higher than the pre-meal. For example, if blood glucose pre-meal was 115 mg/dl, after-meal blood glucose should be no higher than 115 mg/dl.

If any food or combination of foods increase blood glucose more than the pre-meal value, then eliminate the culprit food or reduce the portion size. For example, if dinner consists of baked salmon, asparagus, and mashed potatoes, and pre-meal blood glucose is 115 mg/dl, post-meal 155 mg/dl, reduce or eliminate the mashed potatoes. If slow-cooked, stone ground oatmeal causes blood glucose to increase from 115 mg/dl to 185 mg/dl (a typical response to oatmeal), then eliminate it.

Having immediate feedback on the effects of various foods finally did it for Jack: It identified foods that were triggering excessive blood sugar rises (and thereby insulin) and foods that did not.

What Jack did not do is limit or restrict calories. In fact, I asked him to eat portion sizes that left him comfortable. There was no need to reduce calories, push the plate away, etc. Just don't allow blood sugars to rise.

Six months later, Jack came back 37 lbs lighter. And he got there without calorie-counting, without regulating portion sizes, without hunger.

Martin Levac

12/30/2010 5:14:00 AM |

6 months, 37 lbs. That's pretty good. Immediate feedback is a strong tool for pretty much anything we do. When all we have is a scale, it takes a while for the result to show up. And we're never sure what we did that did it. But when we check blood sugar, we have the result right there and then. Like you said, we know exactly what's the cause and can act on it with total confidence.

Anonymous

12/30/2010 3:37:50 PM |

No problem with this but for the cost.At six (one before, one after, more if you're "grazing") sticks a day @.40 usd each test strip, we're spending $72/mo.This must be lowered somehow.

Anonymous

12/30/2010 6:07:28 PM |

To Anonymous,

$72 / mo is only possible if you are eating different for different meals for the entire month. This is highly unlikely.

Jeff Consiglio

12/30/2010 11:01:26 PM |

Diabetics or pre-diabetics making dietary adjustments based on an objectively measured parameter, such as this, is genius. (I believe constant blood-sugar monitoring is what led Dr. Bernstein to adopt a low-carb diet.)

But what about someone who's not diabetic...a person prone to hypoglycemic episodes for instance.

Seems such an individual's tendency to "overshoot" insulin output in response to incoming carbohydrates would quickly (too quickly)lower blood-sugar levels...giving the false appearance that all is well. Even though much of that glucose got partitioned into fat cells.

Keep up the good work Doc! I'm a personal trainer who regularly sends low-carb disbelieving physician clients of mine to your site. They can obviously receive this kind of info with a more open-mind from a fellow physician than from me.

Ensues

12/31/2010 1:44:01 AM |

I have a very similar story! I lost 30 lbs in just over two months and this blog and Dr. Davis was the entire reason. Total cholesterol down over 30% and triglycerides down over 50%. LDL is much reduced too. My only concern now is HDL. It will not move an inch! Started fish oil, then waited then started vitamin D supplementation. Waited another couple months and earlier this week I started Niacin. My HDL actually went down as Dr. Davis said it would while I was losing weight. Then went right back up to 22 were it's been for years. Might try wine and dark chocolate in moderation and if ALL ELSE fails I will have to submit to exercise. My most sincere thanks Dr. Davis and keep posting actual patient experience. It's very motivating. Can't wait to read about a patient with a "stuck" HDL marker.

Anonymous

12/31/2010 3:50:06 AM |

It costs too much money to buy the strips. I know doctors can get give you prescriptions for the strips at lower costs, but that isn't something my doctor would do.Too bad, it sounds interesting.

Anonymous

12/31/2010 4:53:31 AM |

For those having issues with the cost, ask yourself this: what is my health worth? This motivational tool is key to losing weight and changing your lifestyle intelligently.

Daniel A. Clinton, RN, BSN

12/31/2010 7:05:33 AM |

With 25.1% of Americans either diabetic or prediabetic, it's about time we start thoroughly and intelligently educating patients about how to maintain normal blood glucose levels. The reality is most Americans continue to eat an American diet, conclude blood sugar control thru diet to be impossible, and fall into a never-ending cycle of insulin resistance, pessimism, false comfort in high levels, and an exaggerated concern of hypoglycemia which they use to rationalize running around with blood sugars in the 200s. Proper education and a glucometer the two best tools to combat these epidemics, and yet only a tiny percentage of the population really understands the disease process and proper regimen to maintain good glycemic control. And it's no wonder with the ADA telling people who consider themselves "moderately active" (as most overweight, inactive people do) to eat 45 grams of carbs per meal.Dr. Davis, do you have any suggestions on how to develop a glucose tolerance test patients could perform on themselves at home simply using a fingerstick? Do you think there's value in something as simple as checking a fasting blood sugar, drinking a 20 oz Coke, and then taking fingerstick readings at 1 hour and 2 hours?

Peter

12/31/2010 11:22:24 AM |

What I learned from testing was that brown rice and black beans raise my blood sugar 60 or 70 points, and that if I stayed away from grains, beans, and sugars, my blood sugar doesn't budge. It didn't take many strips to figure this out, the bigger expense is that rice and beans were way cheaper than fish, meat, and cheese.

Anonymous

12/31/2010 2:36:40 PM |

Concern for one's health is a straw man, it's usually everyone's concern; however cost IS an arbiter, otherwise we'd all have "Cadillac" health plans. Technology will lower the strip costs, or eliminate them. In the meantime some do without.

Anne

12/31/2010 2:48:04 PM |

It is easy to find a free meter and it will come with at least 10 strips. This is enough to tell you if your blood sugar is spiking after eating. That is what I did and then I was able to convince my doctor that, in spite of my "normal" fasting BG, I needed a prescription for testing supplies as my postprandial blood glucose was spiking over 200.

Once I figured out what foods were causing my blood sugar to go high, and totally eliminated these foods, testing became much less frequent. The only time I test now is if I add in a new food. I will also test throughout the day every once in a while to be sure my BG is not creeping up even with the low carb lifestyle.

When I started doing this a little over 2 years ago, I lost 15-20 lbs and have remained stable. I no longer have daily episodes of hypoglycemia caused by crashes after a blood sugar spike.

gkamp

12/31/2010 3:43:19 PM |

To penny-wise, pound foolish anonymous,

I would tend to bet that the price of strips is kept artificially high and it is not lack of technology that is the problem. However, think of what you'd spend on a dinner out, a movie, or even a doctor's visit--and a doctor's visit won't give you half of the information about your health that a canister of strips will give you. Anything a doctor does is a single snapshot in time, not ultimately helpful on a day-to-day basis. Testing your blood sugar systematically for various foods works if you pay attention to what it tells you and modify your behavior accordingly.

Derek S.

12/31/2010 5:57:18 PM |

Anonymous,

No, health concern is most definitely not a straw man. Yes, most people will give lip service to their health being a top priority but words mean little. If you observe the hierarchy of priorities in that person's life based on their ACTIONS you will usually quickly see the truth of the matter is that health is NOT one of their top priorities. It is called cognitive dissonance and it is endemic to our society, unfortunately.

If someone is not willing to give up their Starbucks, movies, pricey wines, or any number of other extras in their life in order to obtain something that has tremendous possibilities for improving their health then by their actions they are stating clearly their priorities. Words mean little at that point except to misdirect, evade or confuse the issue. The actions tell the tale.

I would end by saying that your statement about health usually being everyone's concern is simply not true...not because most everyone doesn't say it, because they do, but because most everyone doesn't act according to their words. It has always been true that you can tell a tree by it's fruit.

Derek S.

12/31/2010 6:03:56 PM |

I also want to point out that the old biblical term for cognitive dissonance is "hypocrisy". I usually avoid that term nowadays, though, since it cuts too close to the heart of the matter and therefore makes people very uncomfortable if not downright offended.

Dr. William Davis

12/31/2010 8:10:55 PM |

Thanks, Anne, for making a crucial point: Keep costs low by only assessing a previously untested food or combination of foods.

In other words, if you know that a 3-egg omelette with olive oil and green peppers results in an excellent blood sugar response, don't bother to check it again.

Might-o'chondri-AL

1/1/2011 12:43:45 AM |

"Stuck" HDL was posted 30 Dec. so this may still interest some.

The Linosa study gives low HDL as 54% heritable, and low HDL accompanied with concurrent high Triglycerides as 31% heritable.

The Erasmus Ruchpen study classes HDL as 43% heritable; with both sexes having the same HDL and Triglyceride genetic pre-disposition.

Our individual genetics are probably not from those study pools. However, it has been theorized that the genetic tendency for most Caucasians (like the Korean twins)is to low HDL.

The ratio of Apoliprotein B to Apoliprotein A1 has an inverse effect on HDL. Doc has described to us how he clinically deals with ApoB; HDL reading might not "move" much but being pro-active is preventative.

e4e

1/1/2011 4:46:55 AM |

@Ensues,

You might try increasing sat fat a little. Coconut oil, butter, lard used in cooking can help drive up HDL. It also drives up total cholesterol, but as a ratio, HDL goes up more.

Anonymous

1/1/2011 11:13:25 AM |

Metformin can help with weight loss in the Non Diabetic patient. A great addition to the glucose meter

Anonymous

1/1/2011 12:10:20 PM |

$72 a month is cheaper than weight watchers.

Anonymous

1/1/2011 12:49:28 PM |

Taking niacin to raise HDL worked for me, but it raised my fasting GLU to over 160. Another dangerous side effect for me is that even a small dose will cause me to fly into a rage with the least provocation.

Wal-mart sells a test kit with 50 test strips for under $20 (side-kick).

steve

1/1/2011 4:47:20 PM |

This raises a good question: what is the ideal weight for any individual?

Anne

1/1/2011 5:28:01 PM |

Ensues, Here is a post on Inhuman Experiment about hibiscus tea increasing HDL and lowering LDL.

Roberto

1/2/2011 7:51:17 PM |

Dr. Davis

I had my HbA1C checked while I was eating roughly 60% of my calories from carbohydrate and it was 4.9%. After 3 months on a low-carb diet I had it checked again and it had risen slightly to 5.0%. How could this possibly happen?

Ensues

1/2/2011 11:47:58 PM |

@Many...

Thanks for the tips. I never cease to be amazed by how supportive this community is. I was a SAD poster child always "trying" to follow government guidelines. I made a list of all of the "little" changes I made to conform better. Whole wheat pasta, skim milk, whole wheat bread, no chicken skin etc etc etc. My damaged metabolism took hit after hit after hit. My triglycerides were over 1000. My PCP advised to avoid greasy fried foods. It's comical (and sad) looking back on it. My glucose meter has a permanent place in my laptop bag and my weight goes down every week AND my health improves. Thanks again for the suggestions and data.

Ensues

Anonymous

1/3/2011 12:14:39 AM |

I eat the same foods everyday, so I don't have to test my blood sugar very much. I save money on test strips (I use freestyle lite) and I save money since I buy food in bulk.I think it's important to not eliminate foods just because they raise blood sugar. It's also the combination of foods that affects the glycemic response. There are ways to eat oats and other potentially high glycemic foods with minimal glycemic response. I don't like elevated sugar, but after trying to live on flax alone, I became too depressed to continue. Flax is ok for 1 meal, but that's it for me. One example. I eat semi-pureed sauerkraut with glucomannan and dulse flakes and I get less glycemic response than with sauerkraut alone.

Anonymous

1/3/2011 1:09:19 AM |

I forgot to post my other example of food combining. Quick oats can be processed in a food processor for 2-3 minutes and added to nut butters or perhaps even added to eggs and meats, although I've only tried oats with nut butters. If I eat oats alone once daily, I spike to 150. If I eat oats twice daily, I don't go above 120, so it's about previous meals and also the time of day for me.

Travis Culp

1/3/2011 9:21:33 PM |

Though it's bizarre to me that spending money on health isn't widely accepted as being a good investment, there is a fairly easy way to avoid doing so and still get this information. Why doesn't the good doctor create a central repository that lists various foods/meals and the BG response to them. There must be variation between individuals, but generally speaking, a "bad" food is a bad food. I understand that the point of the process is to rein in recalcitrant patients who need to see what the food is doing, but for those who don't want to spend the money or don't want to do this for another reason, but who do have self-control, we could just share info on which foods cause the biggest response. Presumably they would be grains, sweeteners, high-lactose dairy and fruit eaten on an empty stomach. Meals comprised of mostly meat and green veggies with a serving of carbs (25g or so) should not elicit such a response.

Anonymous

1/5/2011 4:44:12 PM |

Travis Culp,The 'Glycemic Index' may be what you are looking for. To see a very good listing and discussion check out www.mendosa.comAt his site there is a link to Excell listing of GI, this is nice as you can reorder it in assending /desending order. There are also a book.Ed

Cathy

1/5/2011 5:00:32 PM |

My husband was diagnosed as a diabetic and I am prediabetic so I read Dr. Bernstein's book and started testing, testing, testing as suggested. When I went to get the testing strips refilled the pharmacy said I could not get more yet as I was using them too often! After explaining what I had done and that I did not know I was only allowed to use a certain number of sticks a day (two), they refilled it but I think that is wrong for the insurance companies to restrict that. I was glad to read the posts that once you know a food combination does not elevate sugars then you don't need to test then. That helps a lot. Thanks for all of your input. It is a big help to me.

Complications of Diabetes

1/7/2011 9:25:08 AM |

Really liked the way you used to help Jack loose his weight. The results are pretty good and appreciable.Thanks for the post and awaiting to read more.

jem

1/12/2011 6:53:14 PM |

Is it really possible to get NO increase in BG?

I am using this plan and have stopped testing that a m fasting (which is always elevated, for some reason).This has made me way less crazy.

So back to my question....Yesterday my pre breakfast was 70; pp was 96.Lunch was 92; 102

I seem to always have some increase so when peop say they have none, do they really mean none?

The other question; Is the 1 hr pp enough? When I was testing 2 hr the reading was always higher.

So, as you can see, there's much less stress involved w 1 hr pp testing...but am I kidding myself?

Dr. William Davis

1/12/2011 7:29:15 PM |

Jem--

Some people digest and process carbohydrates more slowly, or the mix of foods slows the process.

Find your peak by performing every 30 minute checks, then use that time in future.

Anonymous

1/13/2011 4:38:12 PM |

Does anyone have any experience with Mulberry Zuccarin for glucose control? I read an article about it and came back here to find this thread, hoping for some insight. Just snake oil, or is there something to it?

Karen

2/28/2011 1:17:44 AM |

For people concerned about cost. I bought a walmart store brand meter for 9.00 and 50 strips is 20.00 This meter/strips is a good brand, have no trouble with it. the pharmacist told me she used it personally with no issues. I don't test every day every meal, Great price.